AHIP 2023 Final Exit Exam WITH (VERIFIED QUESTIONS & ANSWERS)

AHIP 2023 Final Exit Exam WITH
(VERIFIED QUESTIONS & ANSWERS)

NEW
Mr. Davies is turning 65 next month. He would like to enroll in a Medicare health plan,
but does not want to be limited in terms of where he obtains his care. What should you
tell him about how a Medicare Cost Plan might fit his needs? - Answer a. Cost plan
enrollees can choose to receive Medicare covered services under the plan's benefits by
going to plan network providers and paying plan cost sharing, or may receive services
from non-network providers and pay cost-sharing due under Original Medicare.
b. Ms. Lopez is considered a marketing representative of BestCare and thus is
obligated to comply with CMS marketing requirements, including those regarding using
only approved call scripts. - Answer Ms. Lopez is an independent agent under contract
with MarketCo, a third-party marketing organization. MarketCo has a contract with
BestCare health plan, a Medicare Advantage (MA) organization, to offer marketing
services through its contracted agents and agencies. Ms. Lopez returns calls to
individuals who contact MarketCo in response to its mailers promoting BestCare health
plan. Which of the following best describes the responsibilities of Ms. Lopez?
a. Ms. Lopez is considered a marketing representative of BestCare but is exempt from
the marketing rules regarding approved call scripts because she works directly for
MarketCo.
b. Ms. Lopez is considered a marketing representative of BestCare and thus is
obligated to comply with CMS marketing requirements, including those regarding using
only approved call scripts.
c. Ms. Lopez no longer needs to be concerned about state licensure since she is
marketing an MA product subject to federal rules.
d. Ms. Lopez needs to maintain state licensure, but because she is working for a thirdparty marketing organization she is exempt from CMS training requirements that apply
to BestCare captive agents.
Mr. Edwards, a marketing representative of the ACME Insurance Company, scheduled
a marketing event and expects about 40 people to attend. He has hired a magician at a
cost of $200 to entertain attendees. Can he do this in a way that complies with guidance
from the Medicare agency? - Answer a. He can do this because the estimated number
of attendees is based on the venue size and response rate and the value of the gift
does not exceed $15.
Mrs. Ramos is considering a Medicare Advantage PPO and has questions about which
providers she can go to for her health care. What should you tell her? - Answer b. Mrs.
Ramos can obtain care from any provider who participates in Original Medicare, but
generally will have a higher cost-sharing amount if she sees a provider who/that is not a
part of the PPO network.
Julia Harris is turning 66 in July, at which time she will retire. She has contacted your
office and requested a meeting so that she can learn about Medicare and the products
you represent. How should you respond? - Answer c. Tell Julia that you will meet with
her to explain Medicare and should she be interested you can accept and submit an
enrollment request, since this is an initial enrollment qualifying her for a special
enrollment period.
Mr. Rivera has Qualified Medicare Beneficiary (QMB) eligibility and is thus covered by
both Medicare and Medicaid. He decides to enroll in a Medicare Advantage (MA) PPO
plan. Later he sees an out-of-network doctor to receive a Medicare covered service.
How much The doctor may only collect from Mr. Rivera the cost sharing allowable under
the state's Medicaid program.may the doctor collect from Mr. Rivera? - Answer The
doctor may only collect from Mr. Rivera the cost sharing allowable under the state's
Medicaid program.